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We should examine user fees: CMA chief

August 23, 2011

Postmedia News

Sharon Kirkey

ST. JOHN'S All options should be on the table for financing an overhaul of Canada's health system - including the possibility of user fees, the outgoing head of the nation's largest doctors' group says.

"We support the Canada Health Act.... We believe that nobody should be denied access to meaningful health services because of their inability to pay," Dr. Jeff Turnbull, president of the Canadian Medical Association, said Monday at the organization's annual general council meeting here. "Those are essential tenets."

But the Ottawa doctor added that he believed " the public would expect us to look at all options."

Dr. Turnbull was responding to the release of an advisory panel's report that is urging the doctors' group to explore a "range of ways of funding services," including user fees, franchises and various insurance schemes.

Dr. Turnbull told reporters it's not clear where charging patients for care "would fit within the context of equity and social justice."

"But I think no stone should be unturned," said Ottawa Hospital's chief of staff. "I think we should look at everything."

The six-member panel says medicare is nearing the "tipping point" and that unregulated privatization is already creeping in "through the back door" as provinces drop more publicly funded services.

If the system isn't transformed, they say, it faces wholesale privatization by default.

"People have to recognize the fact that Canada will have a better health-care system if we can find a way to bring together the public and the private, independent providers," said panel member Tony Dagnone, past chairman of the Ontario Hospital Association and commissioner of Saskatchewan's Patient First Review.

Most people probably don't care if they go to a publicly or privately run clinic for a blood test, "as long as they can pull out their provincial [health] card and it's paid for publicly, and that's what we're saying," panel member Don Drummond of the school of policy studies at Queen's University in Kingston, Ont., told reporters.

"We are talking about no exchange of dollars between that patient and that provider of care," Mr. Dagnone stressed.

But when pressed, the panel members raised the prospect of charging patients $5 for an emergency room visit if they could have been treated at a walk-in clinic.

Critics said the panel's recommendations directly contradict the CMA's own principles around health reform as well as what it heard from Canadians in a series of town hall meetings across the country.

"Instead of leading us towards some thoughtful solutions based on evidence, they seem to be propounding things that we know don't work," said Dr. Bob Woollard of Canadian Doctors for Medicare.

User fees systematically disadvantage patients who need the system most, he said.

Competition could open the door to more private, for-profit care, he said, and "cherry picks the healthiest, wealthiest patients."

"Those who have compliated diseases ... you want to shuffle them out the side door."

The CMA is also calling for a first ministers meeting as soon as possible to address the federal-provincial health accord due to expire in 2014.

The 2014 accord "has to be the foundation for a transformed system," Dr. Turnbull said. "It cannot be just about adding more money. It has to be about meaningful, thoughtful change for better health care for Canadians."

Federal Health Minister Leona Aglukkaq says any new deal on health transfers to the provinces will ensure governments are held accountable for how health-care dollars are spent.

"We want to be able to ensure that the dollars that we are investing in health care are actually going in areas where most needed," Ms. Aglukkaq told reporters at the St. John's meetings.


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